the deep sedation for ablation study

Conditions: Atrial Fibrillation; Ablation; Sedation; Propofol; Dexmedetomidine

Summary: catheter ablation (ca) is an established therapeutic option for patients with symptomatic atrial fibrillation (af). during the procedure, patients are usually sedated and analgesized, most commonly by administration of propofol combined with opioids under the supervision of the electrophysiologist. however, due to the depressive effect of propofol on the respiratory system, this regimen is not without risk. dexmedetomidine is a highly selective alpha 2 agonist that demonstrates both analgesic and hypnotic properties with only weak effect on the respiratory system. the pharmacological profile of dexmedetomidine may be advantageous for sedation during ca of af. the aim of this randomized trial is to test this hypothesis and explore the safety and efficacy of dexmedetomidine during ca of af.

atrial fibrillation (af) is the most common arrhythmia. in symptomatic patients, electroanatomic mapping aided catheter ablation (ca) is an established therapeutic option. the intervention may last several hours, during which patients are required to lie as still as possible, as inadequate patient movements disturb the electroanatomic map, prolong the intervention and increase its complication risks. therefore patients are usually sedated and analgesized, most commonly by administration of propofol combined with opioids under the supervision of the electrophysiologist. despite its wide use, this regimen is not without risk, as propofol has a pronounced depressive effect on the respiratory system. dexmedetomidine is a highly selective alpha 2 agonist that demonstrates both analgesic and hypnotic properties with only weak respiratory depression. by reducing sympathetic activity it also reduces the stress response to an intervention. for these reasons, dexmedetomidine is commonly used in intensive care units, where it has been shown to be well tolerated. consequently, its range of application has been increasingly widened and good experience has been made with its use in transfemoral valve replacement procedures or gastroenterological interventions. the pharmacological profile of dexmedetomidine may be also advantageous for sedation during ca of af. the aim of this randomized trial is to test this hypothesis and explore the safety and efficacy of dexmedetomidine during ca of af.

Eligibility criteria:
inclusion criteria: * age ≥18 years * informed consent as documented by signature * catheter ablation of atrial fibrillation at the department of cardiology, inselspital bern exclusion criteria: * contraindication to sedation by the electrophysiologist * contraindications to either propofol or dexmedetomidine sedation * contraindication for targeted controlled propofol infusion (bmi \> 35) * american society of anesthesiologists (asa) classification \> iii * advanced heart block (second or third degree), if no pacemaker or internal cardioverter defibrillator is implanted * arterial hypotension (mean \< 80 mmhg) * severe heart failure (lvef ≤ 30%) * indication for general anaesthesia * pregnant or breast-feeding women

Keywords: atrial fibrillation ablation sedation anesthesia propofol dexmedetomidine